Abstract
This systematic review and meta-analysis aimed to evaluate whether single-incision laparoscopic surgery (SILS) offers a reliable and effective alternative to conventional laparoscopic surgery (CLS) for the surgical management of ectopic pregnancy, focusing on surgical outcomes and patient recovery.
A systematic review and meta-analysis were conducted, synthesizing data from controlled and observational studies comparing SILS and CLS, with follow-up ranging from immediate postoperative periods to several weeks, depending on study design.
Procedures were performed with patients in the lithotomy position under general anesthesia. SILS utilized a single umbilical port with articulating instruments, while CLS involved multiple trocar sites, with ergonomic considerations varying by surgeon experience and technique.
A total of 880 women with ectopic pregnancies were included across 12 studies identified from database inception to June 15, 2024. Participants were selected based on surgical candidacy, with sample sizes ranging from 20 to 112 per study. Consent was documented in all primary studies per ethical standards, with follow-up data collected postoperatively.
SILS involved a single-incision multi-channel port system, typically at the umbilicus, while CLS employed multiple abdominal incisions for trocar placement, both targeting salpingectomy or ectopic mass removal.
Outcomes were assessed using operative time, blood loss, hospital stay, hemoglobin change, transfusion needs, and bowel function return. SILS significantly reduced blood loss (MD = -51.01 mL, P = 0.004), postoperative hospitalization (MD = -0.24 days, P = 0.003), and time to bowel function return (MD = -1.03 hours, P < 0.01), with comparable operative time and transfusion rates to CLS.
SILS emerges as a groundbreaking, minimally invasive option for ectopic pregnancy, offering reduced blood loss and faster recovery. These findings support its clinical adoption, though further randomized trials are recommended to refine techniques and address heterogeneity, solidifying its role in advancing laparoscopic surgery.